This application is a continuation of international patent application no. PCT/EP00/05385, filed Jun. 13, 2000, designating the United States of America, the entire disclosure of which is incorporated herein by reference. Priority is claimed based on Federal Republic of Germany patent application no. DE 199 27 688.9, filed Jun. 17, 1999.
The present invention relates to a multilayer tablet containing the active substances Tramadol and Diclofenac and/or their in each case physiologically compatible salts, with the active substances being separated from one another by a separating layer.
Tramadol is an analgesic used to treat severe and moderately severe pain, whose mode of action is not based on a pure opioid mechanism. Tramadol does not exhibit the characteristic side effects of an opioid. In some cases nausea is observed as an undesirable accompanying symptom.
Other known, non-opioid analgesics suitable for treating less severe pain include steroid-free analgesics such as Diclofenac-Na, acetylsalicylic acid or Ibuprofen.
Furthermore, for the treatment of moderate to severe pain, the World Health Organization (WHO) recommends combining opioid analgesics with non-steroidal analgesics in order to produce a more effective pain relief and possibly reduce amounts of analgesic which are necessary to administer.
Raffa, European Patent no. EP-B 546 676 discloses, for example, that the combination of Tramadol-HCl with non-steroidal anti-inflammatories, such as for example Ibuprofen, in a composition ratio of 1:1 to 1:200 produces a synergistically enhanced analgesic action and reduces the undesired accompanying symptoms. Tramadol-HCl and Diclofenac-Na form a sparingly soluble compound however. It is therefore to be expected that the bioavailability of the two active substances is reduced and that higher dosages are required in order to compensate for this.
The object of the present invention was accordingly to combine the two active substances Tramadol and Diclofenac and/or physiologically compatible salts thereof, respectively, in a common administration unit without however impairing the release profiles of the two active substances or reducing their bioavailability.
This object is achieved in accordance with the invention by providing a multilayer tablet to be administered orally that contains in at least one layer Tramadol and/or a physiologically compatible salt thereof and in at least one further layer Diclofenac and/or a physiologically compatible salt thereof, with a separating layer being present in each case between the layers containing the active substances.
Preferably the tablet consists of seven layers, particularly preferably of five layers and most particularly preferably of three layers.
Preferred physiologically compatible salts of Tramadol include Tramadol hydrochloride, Tramadol hydrobromide, Tramadol sulfate, Tramadol phosphate, Tramadol fumarate, Tramadol succinate, Tramadol maleate, Tramadol nitrate, Tramadol acetate, Tramadol propionate, Tramadol malonate, Tramadol citrate, Tramadol tartrate, Tramadol benzoate, Tramadol salicylate, Tramadol phthalate and/or Tramadol nicotinate. Particularly preferably Tramadol hydrochloride is used.
Preferred physiologically compatible salts of Diclofenac include Diclofenac-sodium, Diclofenac-potassium, Diclofenac-calcium, Diclofenac-magnesium and/or Diclofenac-cholestyramine. Particularly preferably Diclofenac-sodium is used.
The multilayer tablet to be used according to the invention may contain the conventional auxiliary substances and additives in the Tramadol-containing layer as well as in the Diclofenac-containing layer.
Preferably the multilayer tablet includes one or more layers each respectively containing one of the two active substances, preferably uniformly divided, in a retarding (delayed release) matrix, whereby optimal, individually matched release values can be achieved. By combination with the immediately released active substance an initial dose for a rapid pain relief can be achieved. The slow release from the retarded form permits the maintenance of therapeutic blood levels over an extended time.
The layers may also contain a retarded, particulate form of the respective active substance, preferably granules and/or pellets, particularly preferably pellets produced by extrusion and/or spheronisation. Particularly preferably in this connection the release of the active substance or active substances will be adjusted so that the tablet has to be administered at most twice, and preferably only once per day.
The proportion of the two analgesics in relation to auxiliary substances in the multilayer tablet may be adjusted depending on the desired release duration and amount of the analgesics to be released. Preferably the content of Tramadol is 2 to 60 wt. %, more preferably 5 to 45 wt. %, and most particularly preferably 10 to 35 wt. %, relative to the total weight of the multilayer tablet. Preferably the proportion of Diclofenac is 2 to 30 wt. %, particularly preferably 5 to 25 wt. %, and most particularly preferably 6 to 20 wt. %, relative to the total weight of the multilayer tablet. Based on the known activities of the analgesics, persons skilled in the art know what quantitative ratios of these analgesics should be used in order to achieve the desired effect of the active substances.
Suitable matrix materials useful in the invention include physiologically compatible, hydrophilic materials that are known to persons skilled in the art. Preferred hydrophilic matrix materials include polymers, particularly preferably cellulose ethers, cellulose esters and/or acrylic resins. Most particularly preferred matrix materials include ethylcellulose, hydroxypropylcellulose, hydroxypropylmethylcellulose, hydroxymethylcellulose, poly(meth)acrylic acid and/or derivatives thereof such as its salts, amides or esters.
Particularly preferably there is used as physiologically compatible material for a retarding matrix at least one cellulose ether and/or cellulose ester whose 2 wt. % aqueous solution at 20xc2x0 C. has a viscosity of 3,000 to 150,000 mPxc2x7as, preferably 10,000 to 150,000 mPxc2x7as, optionally in combination with a filler that is not swellable in an aqueous medium, such as for example calcium hydrogen phosphate, or with an insoluble filler that is swellable in an aqueous medium, such as for example microcrystalline cellulose, or a filler that is soluble in aqueous media, such as for example lactose.
Also preferred is a matrix material of hydrophobic materials such as hydrophobic polymers, waxes, fats, long-chain fatty acids, fatty alcohols or corresponding esters or ethers or their mixtures. Particularly preferably monoglycerides or diglycerides of C12-C30 fatty acids and/or C12-C30 fatty alcohols and/or waxes or their mixtures are used as hydrophobic materials.
It is also possible to use mixtures of the aforementioned hydrophilic and hydrophobic materials as a retarding matrix material.
In one preferred embodiment the separating layer is slightly permeable with respect to the two active substances also on contact with aqueous body fluids. This separating layer is preferably composed of a polymer, a wax, a fat, a fatty acid, a fatty alcohol or a corresponding ether or ester or a mixture thereof, and has a melting point of xe2x89xa740xc2x0 C.
Preferred physiologically compatible polymers which may be used in the invention include cellulose acetate, ethylcellulose, cellulose butyrate, polyethylene or ethylene/vinyl acetate copolymers.
In a further preferred embodiment the separating layer is more specifically readily permeable with respect to the two active substances per se on contact with aqueous body fluids, the thickness of the separating layer then being adjusted however so that the two active substances do not come into contact with one another during the duration of the release.
To this end a permeable separating layer of the tablet may consist of hydroxypropylmethylcellulose, hydroxyethylcellulose, hydroxymethylcellulose and/or hydroxypropylcellulose.
Furthermore the separating layer as well as the active substance-containing layers may include further auxiliary substances and additives. These may be fillers, preferably lactose, microcrystalline cellulose or calcium hydrogen phosphate, or slip agents, lubricants and/or flow regulating agents and/or plasticisers, preferably highly dispersed silicon dioxide, talcum, magnesium stearate and/or stearic acid.
The individual layers of the multilayer tablet according to the invention may also be formulated so that they separate from one another on contact with aqueous body fluids and thus release the active substances in a spatially separated manner. As physiologically compatible release agents that release the layers from one another on contact with aqueous body fluids, there may be used Crospovidon, Croscarmelose, sodium starch glycolate, starch and/or hydroxypropylcellulose having a low degree of substitution.
The present invention accordingly provides multilayer tablets that contain at least one release layer that effects a separation of the different layers from one another on contact with aqueous body fluids. It is however also possible for the layers to remain combined with one another on contact with aqueous body fluids and to release the active substances, separated by the separating layer, independently of one another.
With the multilayer tablet according to the invention a controlled release of both active substances can also be achieved by means of a coating that permits a controlled, as a rule delayed, release of the active substance in an aqueous medium. Suitable retard coatings include water-insoluble waxes or polymers, such as for example acrylic resins, preferably poly(meth)acrylates, or water-insoluble celluloses such as ethylcellulose. These materials are known from the prior art, e.g. Bauer, Lehmann, Osterwald, Rothgang xe2x80x9cxc3x9cberzogene Arzneiformenxe2x80x9d (xe2x80x9cCoated Medicament Formsxe2x80x9d), Wissenschaftliche Verlagsgesellschaft mbH Stuttgart, 1988, p. 69 ff. They are introduced here by way of reference.
In addition to the water-insoluble polymers, in the coating there optionally may also be used non-retarded, preferably water-soluble, polymers in order to adjust the release rate of the active substance, in amounts of up to 30 wt. %, such as polyvinylpyrrolidone or water-soluble celluloses, preferably hydroxypropyl-cellulose, hydroxypropylmethylcellulose or, or water-soluble pore-forming agents such as, for example, lactose, NaCl, sucrose, and/or known plasticisers.
In addition to the retarding coating, the multilayer tablet according to the invention may also be provided with further coatings. One such further coating may for example dissolve in a manner dependent on the pH value. In this way a specific amount of active substance can pass undissolved through the stomach and be released only in the intestinal tract.
The multilayer tablet according to the invention may also have at least one score mark that enables the dose being administered to be subdivided, preferably halved. This permits the dosage to be matched to the individual requirements of the patient, corresponding to the amount of the analgesics to be administered individually.
The invention accordingly also provides multilayer tablets that have at least one score mark that enables the tablet to be subdivided, preferably halved.
The multilayer tablets are produced according to known methods, such as are described for example in R. Voigt, xe2x80x9cLehrbuch der pharmazeutischen Technologiexe2x80x9d, 6th Edition, p. 225 ff. They are introduced here by way of reference.
Preferably the production of the multilayer tablets is carried out by combining the constituents of the individual layers first of all separately by mixing the individual constituents in a mixer, optionally followed by granulation. The different layers are then compressed in succession in a tablet press, preferably in a rotary pelleting machine to form a tablet, in such a way that the separating layer prevents the active substance-containing layers from coming in contact with one another.
The multilayer tablets according to the invention may be of the usual shapes and sizes. If the multilayer tablet according to the invention contains coatings, then these may be applied by conventional processes, such as for example dragxc3xa9e coating, spraying of solutions, dispersion or suspensions, by melt processes or by powder application processes.
If the multilayer tablet according to the invention is intended to be administered twice a day, the release profile for the active substance Tramadol from the multilayer tablet according to the invention is preferably controlled so that the released amount of Tramadol in percent referred to the total amount is 2 to 40%, preferably 5 to 30% after 30 minutes, 5 to 80%, preferably 20 to 60% after 120 minutes, 30 to 90%, preferably 35 to 75% after 240 minutes, 50 to 95%, preferably 60 to 90% after 360 minutes, 60 to 100%, preferably 70 to 100% after 480 minutes, and 70 to 100%, preferably 75 to 100% after 600 minutes.
The release profile for the active substance Tramadol from the multilayer tablet according to the invention for once daily administration is preferably controlled so the released amount of Tramadol in percent, relative to the total amount, is 2 to 40%, preferably 5 to 30% after 60 minutes, 5 to 80%, preferably 20 to 60% after 240 minutes, 30 to 90%, preferably 35 to 75% after 480 minutes, 50 to 95%, preferably 60 to 90% after 720 minutes, 60 to 100%, preferably 70 to 100% after 960 minutes, and 70 to 100%, preferably 75 to 100% after 1200 minutes.
The release profile for the active substance Diclofenac from the multilayer tablet according to the invention for a twice daily administration is preferably controlled so that so that the released amount of Diclofenac in percent referred to the total amount is 0% after 30 minutes, xe2x89xa65% after 120 minutes, 5 to 50%, preferably 10 to 35% after 240 minutes, 30 to 95%, preferably 35 to 80% after 480 minutes, and 45 to 100%, preferably 60 to 100% after 600 minutes.
The release profile for the active substance Diclofenac from the multilayer tablet according to the invention for once daily administration is preferably controlled so that the released amount of Diclofenac in percent relative to the total amount is xe2x89xa65% after 120 minutes, 5 to 40%, preferably 10 to 30% after 240 minutes, 15 to 60%, preferably 15 to 50% after 480 minutes, 30 to 80%, preferably 35 to 80% after 720 minutes, and 50 to 100%, preferably 60 to 100% after 1,200 minutes.
The present invention accordingly provides multilayer tablets that are characterized in that in the case of twice daily administration, xe2x89xa770% of the Tramadol and xe2x89xa760% of the Diclofenac, respectively, are released within 8 hours. The invention furthermore provides multilayer tablets that are characterised in that in the case of once daily administration, xe2x89xa770% of the Tramadol and xe2x89xa760% of the Diclofenac, respectively, are released within 16 hours. With gastric juice-resistant tablets, the aforementioned release profiles with regard to the Tramadol release times as well as the residence time in the stomach should be appropriately readjusted.